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Liability fears drive wide variations in care

A study suggests some tort reform is needed to cut unnecessary tests and remove treatment disparities, while another says patient safety improvements would cut claims.

By Amy Lynn Sorrel — Posted April 30, 2010

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Medical liability pressures continue to influence physicians' treatment decisions and contribute to wide variations in health care practices and costs around the country, a recent study found.

About one in four cardiologists reported ordering potentially unnecessary heart tests, spurred from fear of getting sued, according to an April 13 online report in the American Heart Assn. journal Circulation: Cardiovascular Quality and Outcomes.

The nationwide survey of 598 cardiologists asked if certain nonclinical factors affected decisions to order cardiac catheterization. Nearly 24% said they recommended such tests to protect against a lawsuit. Twenty-seven percent cited peer pressure, saying they ordered the procedures because a colleague would do so in the same situation.

Researchers also asked the doctors if the expectations of patients or referring physicians played a role. Only liability fears were significantly linked to regional differences in health care utilization, the study showed (link).

"We've studied variation for a long time, and we know people get different health care delivered to them depending on where they live," said lead study author Lee Lucas, PhD, an epidemiologist and associate director of the Center for Outcomes Research and Evaluation at the Maine Medical Center in Portland, Maine.

While various factors play into such disparities, "I do think the study provides some evidence that [liability] reform might help" guard against defensive medicine practices, she said.

One possible approach could be boosting patient safety measures to help improve the medical liability climate, according to a report issued April 15 by the RAND Corp.'s Institute for Civil Justice (link).

The study by the nonprofit research organization found that a reduction in preventable medical errors coincided with a drop in malpractice complaints, after comparing incidence of nearly 20 different types of adverse events with liability claims frequency at several California hospitals from 2001 to 2005.

Based on such connections, hospitals in a county that experience an average decrease of 10 adverse events in a given year could expect to see an average annual reduction of 3.7 liability claims, researchers concluded.

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